Surgical Rescue and Hematoma Resorption Rate in Octogenarians and Nonagenarians Undergoing Middle Meningeal Artery Embolization for Chronic Subdural Hematoma.

BACKGROUND

With intuitively increased risks of surgery in octogenarians and certainly nonagenarians, reliance on middle meningeal artery embolization (MMAE) to manage chronic subdural hematoma (CSDH) in these elderly patients is substantial, while clinical trials underrepresent this group.

METHODS

An institutional database was queried for patients aged ≥80 years undergoing MMAE for CSDH. Surgical rescue/reoperation rate and hematoma resolution within 6 months of follow-up were further compared between nonagenarians and octogenarians. The impact of age was adjusted in a multivariate model controlling for gender, antithrombotic medications, CSDH radiographic and clinical baselines, and MMAE angiographic results.

RESULTS

Of 494 consecutive MMAE procedures for CSDH, 32% (n = 160) were in patients aged ≥80 years (maximum 97 years): 53 nonagenarians and 107 octogenarians. MMAE was a standalone procedure for 70% of cases and an adjunct to surgery in 30%. The overall rate of surgical rescue/reoperation was 8.1% (n = 13); this was similar between nonagenarians and octogenarians (5.7% vs. 9.3%, P = 0.42). However, in patients not undergoing surgery, the rate of satisfactory hematoma resolution within 6 months was lower in nonagenarians compared with octogenarians (68% vs. 87%, P = 0.01), and in the subgroup of standalone MMAE, the time to 50% hematoma resolution was longer in nonagenarians (median 57 days vs. 41 days, P = 0.04). Multivariate analyses confirmed the association between slower hematoma resolution and nonagenarian age (adjusted odds ratio 0.17, 95% confidence interval [0.06-0.55], P = 0.003).

CONCLUSIONS

While MMAE still mitigates the risk of additional surgery for over 90% of nonagenarians with CSDH, these patients are noted to have slower hematoma resolution radiographically.